OVERVIEW

Question this study addresses:

NOTE: THE ANALYSES CONTAINED HEREIN ARE FOR THE CMS ABSTRACT ONLY.
ADDITIONAL ANALYSES AND RESULTS FOR THE POSTER WILL BE IN A DIFFERENT FILE.

ABSTRACT

Title

Significant differences in sleep and depression among chronic pain groups: Implications for patient education

Purpose

Chronic pain (CP) is a widespread and costly condition, affecting nearly 100 million Americans and costing over $600 billion annually. Evidence suggests that compared to healthy controls (HC), chronic pain populations experience problems with sleep and depression. Less understood is how whether these problems are differentially experienced by different chronic pain conditions (i.e., chronic low back pain and fibrimyalgia). To address this questions, questionnaire data regarding sleep, depression and pain were collected.

Subjects

Data was collected from 158 participants (HC = 50, 27 females); CLBP = 64, 41 females; FM = 44, 39 females). This study was approved by the Institutional Review Board at the University of Missouri.

Methods

For this study, participants were recruited from the Columbia, Missouri community and surrounding small towns (Ashland, Booneville, and Moberly). Recruitment flyers were posted in clinics that often treat chronic pain diseases and on a weekly news bulletin email distributed to faculty, staff, and students affiliated with MU or university hospital. For the CLBP group, inclusionary criteria were established to incorporate individuals (1) experiencing CLBP for greater than the past 6 months that fulfills at least one of Quebec Task Force and Spinal Disorders diagnostic criteria, (2) no history of a severe psychological or neuropsychological disorder. Specific criteria for the HC group included (1) no history of chronic pain, severe psychological or neuropsychological disorder. All participants for this study provided written consent.

As part of the study, participants completed a variety of questionnaires that assessed pain, sleep and affect. Specifically, participants completed the Beck Depression Inventory-II (BDI-II), Epworth Sleepiness Scale, McGill-Melzack Pain Questionnaire and Pittsburg Sleep Quality Index (PSQI). A subgroup of participantas also completed the Insomnia Severity Index.

This material could probably be dropped
For all groups, potential participants were excluded if (1) they could not refrain from usage of analgesics the day before and of their scan, (2) tested positive on a pre-MRI metal screening, (3) were pregnant, (4) and/or did not display pain symptoms consistent with Quebec Task Force and Spinal Disorders diagnostic criteria.

Results

An ANOVA with Tukey Honest Significant Differences (TukeyHSD) testing was carried out using RStudio (Version 1.2.5033). The overall test for a main effect of group was significant for all but three variables (i.e., Sleef Effiency, Daytime Dysfunction and Total Time in Bed). PostHoc follow up testing using TukeyHSD revealed the presence of significant group differences for all but the same two variables listed above. However, the FM-HC comparison trended toward significance with p ≤ 0.07.

Conclusions

Clinical Relevance

This study supported by NINR grant #R01NR015314

START

DATA

Import data from GitHub

PSQI

  • The global PSQI score is then calculated by totaling the seven component scores, providing an overall score ranging from 0 to 21, where lower scores denote a healthier sleep quality.

  • A PSQI Global score ≥ 5 is the clinical cutoff score (i.e., sleep problems)

  • The PSQI data has been updated, processed, clean and scored

  • NOTE: I need to add a section that discusses the PSQI cutoff. Anything over “5” is considered significant.

INITIAL DATA SETS

Create a small dataset (dat.sm) that includes only the variables of interest.

VARIANCE CHECK

Which variable(s) in the dat.sm data has potential issues with variances?

[1] "slpDist"

SAMPLE DESCRIPTIVES

Group by sex for overall sample.
Entire Sample
Sex
Group Female Male Total
HC 27 23 50
CLBP 41 23 64
FM 39 5 44
Total 107 51 158

Means and SDs for each group.


 Descriptive statistics by group 
group: HC
              vars  n mean   sd   se
group.factor*    1 50 1.00 0.00 0.00
slpQual          2 50 0.76 0.62 0.09
slpLat           3 50 0.94 0.79 0.11
slpDur           4 50 0.80 0.70 0.10
slpEff           5 50 1.32 1.35 0.19
slpDayFcn        6 50 0.30 0.46 0.07
psqi_Global      7 50 5.38 2.70 0.38
ess_total        8 50 5.90 2.84 0.40
bdi_total        9 50 3.26 4.04 0.57
mcgill_total    10 50 1.56 6.20 0.88
------------------------------------------------------------ 
group: CLBP
              vars  n  mean    sd   se
group.factor*    1 64  2.00  0.00 0.00
slpQual          2 64  1.20  0.78 0.10
slpLat           3 64  1.28  0.83 0.10
slpDur           4 64  0.86  0.71 0.09
slpEff           5 64  1.33  1.31 0.16
slpDayFcn        6 64  0.22  0.42 0.05
psqi_Global      7 64  6.47  2.83 0.35
ess_total        8 64  6.88  3.48 0.44
bdi_total        9 64 10.12  8.60 1.08
mcgill_total    10 64 24.94 14.93 1.87
------------------------------------------------------------ 
group: FM
              vars  n  mean    sd   se
group.factor*    1 44  3.00  0.00 0.00
slpQual          2 44  1.77  0.74 0.11
slpLat           3 44  2.11  1.04 0.16
slpDur           4 44  1.43  1.00 0.15
slpEff           5 44  1.68  1.33 0.20
slpDayFcn        6 44  0.11  0.32 0.05
psqi_Global      7 44  9.75  3.86 0.58
ess_total        8 44  8.23  4.05 0.61
bdi_total        9 44 16.11  9.31 1.40
mcgill_total    10 44 35.57 13.12 1.98
------------------------------------------------------------ 
group: TRUE
NULL

#PLOTS

CORR PLOTS

The end of corr plots

BAR PLOTS

BOX PLOTS

ANOVA (Main effect of group)

ANOVA full model
Name p.value
slpQual 1.87e-09
slpLat 4.37e-09
slpDur 0.000197
slpEff 0.318
slpDist 0.0365
slpMeds 9.37e-09
slpDayFcn 0.0906
psqi_Global 4.43e-10
ess_total 0.00597
isi_total 7.57e-10
bdi_total 1.29e-12
mcgill_total 4.96e-28
TIB 0.865
Note:
Red = Significant main effect for group (p ≤ 0.05)

POSTHOC

PostHoc group comparisons: See Note at table end
comparison diff conf.low conf.high adj.p.value
Sleep Quality
CLBP-HC 0.443 0.120 0.766 0.00411
FM-HC 1.013 0.659 1.367 7.56e-10
FM-CLBP 0.570 0.234 0.905 0.000268
Sleep Latency
CLBP-HC 0.341 -0.052 0.735 0.103
FM-HC 1.174 0.743 1.604 4.1e-09
FM-CLBP 0.832 0.424 1.240 9.81e-06
Sleep Duration
CLBP-HC 0.059 -0.297 0.415 0.918
FM-HC 0.632 0.242 1.022 0.000535
FM-CLBP 0.572 0.203 0.942 0.00098
Sleep Efficacy
CLBP-HC 0.008 -0.584 0.600 0.999
FM-HC 0.362 -0.287 1.010 0.386
FM-CLBP 0.354 -0.261 0.968 0.363
Sleep Disturbance
CLBP-HC 0.060 -0.000 0.120 0.0512
FM-HC 0.060 -0.006 0.126 0.0829
FM-CLBP 0.000 -0.063 0.063 1
Sleep Medications
CLBP-HC 0.258 -0.208 0.724 0.391
FM-HC 1.316 0.806 1.827 2.38e-08
FM-CLBP 1.058 0.575 1.542 2.03e-06
Sleep Daytime Functioning
CLBP-HC -0.081 -0.264 0.101 0.544
FM-HC -0.186 -0.386 0.013 0.0732
FM-CLBP -0.105 -0.294 0.084 0.39
PSQI Global
CLBP-HC 1.089 -0.303 2.480 0.156
FM-HC 4.370 2.846 5.894 6.86e-10
FM-CLBP 3.281 1.838 4.725 8.11e-07
ESS Total
CLBP-HC 0.975 -0.574 2.524 0.299
FM-HC 2.327 0.631 4.023 0.00406
FM-CLBP 1.352 -0.255 2.959 0.118
ISI Total
CLBP-HC 4.171 0.547 7.794 0.0199
FM-HC 10.250 6.728 13.772 2.19e-09
FM-CLBP 6.079 3.080 9.079 1.64e-05
BDI Total
CLBP-HC 6.865 3.426 10.304 1.53e-05
FM-HC 12.854 9.087 16.620 5.43e-13
FM-CLBP 5.989 2.420 9.557 0.00032
McGill Total
CLBP-HC 23.378 17.897 28.858 1.42e-14
FM-HC 34.008 28.006 40.010 0
FM-CLBP 10.631 4.944 16.317 5.38e-05
Time in Bed
CLBP-HC -0.439 -5.355 4.476 0.976
FM-HC -1.215 -6.598 4.168 0.855
FM-CLBP -0.776 -5.876 4.324 0.931
Note:
Red = Significant group tests (p ≤ 0.05)

STOP HERE

ISI ANALYSES

This set of analyses uses a subset of subjects who have completed the ISI

Also create a dataset of subjects with ISI data (dat.isi).

ISI DATA VARIANCE

The variable(s) in the ISI data with variance issues are:

END - BEYOND HERE IS EXPLORATORY